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Year 3: Reproduction > Treatment of breast disease > Flashcards

Treatment of breast disease Flashcards

(51 cards)

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1
Q

breast cancer affects?

A

1 in 8 women

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2
Q

Risk factors for breast cancer? (8)

A
  • increasing age
  • previous breast cancer
  • genetic (5%)
  • Early menarche and late menopause
  • Late or no pregnancy
    HRT
  • Alcohol (>14 units per week)
  • Weight
  • Post Radiotherapy treatment for Hodgkin’s disease
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3
Q

presentation: asymptomatic

A

breast screening - 50-70 years

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4
Q

symptomatic presentation includes? (9)

A
  • Lump
  • Mastalgia (persistent unilateral pain)
  • Nipple discharge (blood-stained)
  • Nipple changes (Paget’s disease, retraction)
  • change in colour of areola
  • redness or pitting of skin- like orange skin
  • Change in the size or shape of the breast
  • Lymphoedema (Swelling of the arm)
  • Dimpling of the breast skin
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5
Q

new patient clinic - radiological?

A

Bilateral mammograms / USS

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6
Q

new patient clinic - CYTO-PATHOLOGICAL?

A
  • FNA- cells only (cytology)

- Core Biopsy- tissue (histo-pathology)

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7
Q

Clinical assessment - history

A

Present Complaint
Previous Breast Problems (prevention cysts or cancers)
Family History of breast or ovarian cancer
Hormonal Status
Drug History - blood thinning?

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8
Q

Clinical assessment - examination

A

BOTH Breasts, Axillae, SCF

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9
Q

most common sign and symptom

A

lump or thickening in breast. Often painless

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10
Q

how can the breast be imaged?

- what is most sensitive

A

mammography, ultrasound or MRI

- mammography

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11
Q

why is sensitivity reduced in younger women to mammography?

A

due to the presence of increased glandular tissue (<35yrs)

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12
Q

what Is FNA?

A

Fine Needle Aspiration

-> Cytology

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13
Q

what is core-biopsy

A

Histo-Pathology
Invasive versus in-situ
ER, PR, HER2 receptor status

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14
Q

most accurate test

A

FNA cytology
Mammography
examination/ultrasound

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15
Q

80 % of breast cancers are

10% can be

A

Ductal Carcinoma - come from the ducts

  • lobular carcinoma- milk producing cells

10% = others

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16
Q

non invasive breast cancers?

A

DCIS - Ductal Carcinoma In Situ

LCIS - Lobular Carcinoma In Situ)

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17
Q

management of cancer (3 steps)

A

1 . Diagnose the disease

  1. Staging of the disease
  2. Definitive treatment
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18
Q

Assessing the severity (“Staging”) (4)

A
  • FBC, U&Es, LFTs, Ca2+/PO2-
  • Chest x ray
  • Others as clinically indicated
  • No reliable tumour markers
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19
Q

T - staging - T0 means?

A

Primary tumour not palpable

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20
Q

what does T1 mean?

A

Clinically palpable tumour -size < 2 cm

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21
Q

T3 means?

Study These Flashcards
A

Tumour size > 5 cm

22
Q

T4a when?

Study These Flashcards
A

skin invasion

23
Q

T4b when?

Study These Flashcards
A

invading chest wall

24
Q

T4c when?

Study These Flashcards
A

invading both

25
T4d when?
inflammatory breast cancer - worst kind
26
N - Regional Lymph Nodes staging?
N0 - No Regional lymph nodes palpable N1 - Regional lymph node palpable- mobile N2 - Regional lymph node palpable- fixed
27
M - Distant Metastasis staging ?
Mx - Distant metastasis cannot be assessed M0 - No distant metastasis M1 - Distant metastasis
28
Management/ Treatment Neo-Adjuvant means?
treatment that has happened before surgery
29
Management/ Treatment -Adjuvant means?
treatment after surgery
30
management types?
Surgery +/- Radiotherapy +/- Chemotherapy +/- Hormonal Therapy
31
2 main types of breast surgery?
- Breast conservation surgery | - Mastectomy
32
Patients suitable for breast conservation surgery?
Tumour size clinically <4cm – IN THE OLD DAYS - Breast/Tumour size ratio - Suitable for radiotherapy - Single tumours – IN THE OLD DAYS - Patient’s wish – most important!!
33
what node is first to receive lymphatic drainage?
sentinel
34
first node tumour will spread to
sentinel
35
is the SLN is negative..
clear of tumour) | – no further treatment required
36
If SLN contains tumour ..?
either remove them all surgically (clearance= ANC) or give radiotherapy to all the axillary nodes
37
Complications of axillary treatment? (6)
- Lymphoedema (10-17%) - can be mild or severe - sensory disturbance (intercostobrachial n.) - decrease ROM of the shoulder joint - nerve damage (long thoracic, thoracodorsal, brachial plexus) vascular damage - radiation-induced sarcoma
38
Factors associated with increased risk of disease recurrence?
- Lymph node involvement - Tumour grade - Tumour size - Steroid receptor status (negativity- ER/PR neg) - HER2 status (positivity- HER2 pos) - LVI- lymphovascular invasion
39
Prevention - local
radiotherapy
40
prevention - systemic
- Hormone therapy - Chemotherapy - Targeted therapies
41
after surgery most patients will get
radiotherapy
42
Complications of radiotherapy (4)
Skin reaction- Skin telangiectasis Radiation pneumonitis Cutaneous Radionecrosis/ Osteonecrosis Angiosarcoma
43
hormone therapy is only given for?
oestrogen positive receptors
44
2 examples of Aromatase Inhibitors
Arimidex (1mg) & | Letrozole (2.5mg)
45
drug you can give in hormone therapy?
Tamoxifen
46
chemotherapy has best benefit
young women under 50 - more higher risk cancers - grade 3, LN pos, ER neg, HER2 pos
47
HER2 positivity and Anti-HER2 therapy- what drug?
Trastuzumab (Herceptin®)/Pertuzamab
48
why use HER2 positivity ? (4)
- Monoclonal antibody against HER-2 receptor - Given to patients with over-expression of HER2 and chemotherapy - 50% decrease risk of recurrence - 33% increase in survival at 3 years!
49
Follow up?
- Clinical examination for 1-5 years | - Mammogram of breast(s) at yearly intervals for 3-10 years
50
metastatic spread? Local
Chestwall Skin Nipple
51
metastatic spread - Distant - give them in order
Contralateral Breast ``` Bone Lung Liver Brain Bone Marrow ```

Year 3: Reproduction (40 decks)

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